8 Hepatitis B

8.8 Public health measures

The elimination of hepatitis B virus (HBV) transmission is now a realistic public health goal,55 especially with the proven effectiveness and safety record of hepatitis B vaccine.56

Large increases in hepatitis B vaccine coverage and the inherently long interval of time to achieve vaccine-related reductions in HBV acute and chronic disease can undermine support for hepatitis vaccination in the face of seemingly urgent competing priorities. However, it is important to ensure vaccination programmes are maintained for the at-risk populations.

It is a legal requirement that all cases of acute hepatitis B infection be notified immediately on suspicion to the local medical officer of health.

Babies born to HBsAg-positive mothers should be notified at birth. The prevention of perinatal transmission is covered in section 8.5.3.

8.8.1 Passive immunisation

Hepatitis B immunoglobulin (HBIG) is prepared from donated blood plasma and contains high levels of anti-HBs antibody (see section 1.5). It is given after exposure to HBV and provides passive anti-HBs antibody protection against acute and chronic HBV disease. HBIG prophylaxis is ideally given in combination with the hepatitis B vaccine to confer both passive and active immunity after exposure.

The efficacy of HBIG alone in preventing clinical hepatitis B infection is about 75 percent in adults, but the protection lasts only for a few months.1

Whenever immediate protection is required, immunisation with a vaccine should be combined with simultaneous administration of HBIG at a different site. It has been shown that passive immunisation with HBIG does not suppress the active immune response to vaccination. A single dose of HBIG (usually 400 IU for adults, 100–110 IU for the newborn, see Table 8.4) is sufficient. If infection has already occurred at the time of the first immunisation, virus replication is unlikely to be inhibited completely, but severe illness and, more importantly, the development of chronic HBV infection may be prevented, particularly in the infants of HBsAg-positive mothers.

Table 8.4: Hepatitis B immunoglobulin (HBIG) doses

Age HBIG dose
Neonates (under 1 month) 100–110 IU*
1 month to 4 years 200 IU
5 to 9 years 300 IU
10 years to adult 400 IU

* The HBIG presentation for neonates may be 100 or 110 IU units.

The following individuals should receive HBIG and the hepatitis B vaccine:

For more details on control measures, refer to the Communicable Disease Control Manual 201231 or the Control of Communicable Diseases Manual.57